Report on Exemplary and Best Practices in
Disaster Preparedness and Emergency Response
For People with Disabilities ◦
Glen W. White, Principal Investigator
Michael H. Fox, Co-Investigator
Catherine Rooney, Project Coordinator
Prepared by
Research and Training Center on Independent Living
University of Kansas
March 15, 2007
◦
Objective Three, Part 2
Introduction
The Nobody Left Behind (NLB): Disaster Preparedness for Persons with Mobility
Impairments research study determined the readiness of emergency management sites
across the United States to assist persons with mobility impairments during disasters.
This research was under the direction of Glen
W. White, Principle Investigator, and Michael
H. Fox, Co-Investigator, at the University of
Kansas, Research and Training Center on
Independent Living (RTC/IL). Thirty randomly
selected sites that had experienced a Federal
Emergency Management Agency (FEMA)
declared disaster during 1998-2003 were the focus of the research. Emergency
managers at each site were surveyed by telephone and their local emergency plans
were reviewed. Experts in disaster preparedness and response and/or people with
disabilities assisted in the project as advisors.
One component of the NLB project was to identify exemplary polices, practices,
and programs in emergency management designed to assist persons with mobility
limitations. The identified exemplary situations are the basis of this white paper. With
the support of policy makers in emergency management and disabilities, these
practices can serve as catalysts for change, which may be emulated by other counties,
cities, parishes, or boroughs.
Results
Exemplary Emergency Management Practices
Interviews with the emergency managers helped determine whether guidelines
were in local emergency plans to assist persons with mobility impairments. 1 Six sites
out of 30 self identified that their local emergency management plan included such
guidelines. Among these 6 sites, there was a 50/50 split between urban and rural
locations. Two of these 6 sites included a nuclear facility plant in their jurisdiction which
indicates additional responsibilities as well as financial resources to address these
responsibilities.
What distinguishes these six sites as exceptional compared to the other sites in
the study is the cumulative effect of policies and practices that they employed. Thus,
these sites took a comprehensive approach to addressing the needs of persons with
disabilities, including mobility impairments.
1
Fox, M.H., White, G.W., Rooney, C., & Rowland, J. (spring, 2007). Disaster preparedness and
response for persons with mobility impairments: Results from the University of Kansas Nobody
Left Behind project. Journal of Disability Policy Studies, 17 (4) 196-205.
3
Table 1 illustrates the six emergency management practices that the sites
identified to assist persons with disabilities, including mobility impairments. These
management practices included having guidelines and the inclusion of the disability
community in planning. Each of the sites had at least three out of six emergency
management practices, making for a more extensive approach to assisting persons with
disabilities than the other sites.
Table 1
Emergency Management Practices Including the Needs of Persons
with Mobility Impairments and the Corresponding Number and
Percentage of the Six Exemplary Sites with these Practices
Emergency Management Practices
Number of the 6
Sites with
Practice
Guidelines to assist persons with mobility impairments.
6
Surveillance identification of persons with mobility impairments.
5
Consumer outreach for persons with mobility impairments.
1
Customer service delivery in transportation, sheltering, problem
solving, etc. as related to the needs of persons with mobility
impairments.
5
Education and training about the disability community and their
needs in disaster preparedness and response.
3
Inclusion of persons with disabilities in the local planning process,
and/or in training drills of responders.
6
Specific consumer services delivery included:
1. Administering and maintaining a surveillance system, usually a self-identified registry
system of persons needing assistance during a disaster or emergency;
2. Identifying accessible transportation vehicles and guidelines to evacuate persons
with disabilities needing assistance;
3. Establishing a so called special medical needs shelter; and
4. Conducting training and exercises on evacuation of persons with disabilities.
Among the sites that did not consider their plan as having guidelines to assist
persons with mobility impairments, several also administered registries, identified
accessible transportation, evacuated persons with disabilities, established shelters, or
4
conducted training and/or exercises on evacuation of persons with disabilities. 2 Yet, the
norm was to have a few policies aimed at addressing one specific disability and issue.
For example, it was common to have policies on communication or warning alternatives
for the hearing impaired. However, the remaining assistance needs of persons with
disabilities, including persons with mobility impairments, were missing from the plans or
practices.
Inclusion of Persons with Disabilities
The figures on Table 1 on page 4 show that only half of the exemplary sites
reported having training in assistance needs of persons with disabilities. These findings
support previous NLB recommendations on the need for better educated emergency
management personnel regarding disabilities and disaster management. 3
It is a must that active representation across
“Today there is more
disabilities be included at the planning table, not just
emphasis on animals in a
service providers or advocates for the elderly.
disaster than disabilities. I
Persons with disabilities have much to contribute to
hate to say it.”
emergency management efforts, as shown by the
preparedness tip sheets developed for and by
Emergency Manager, NLB Study
persons with mobility impairments in Attachments 1
and 2. From personal experiences, these
preparedness tips were formulated from responses to an online survey conducted by
the NLB project. Inclusion of persons with disabilities in emergency management can
lead to more effective preparedness for individuals and the community.
A resource to assist managers in this area is a white paper commissioned by the
NLB study called, “Why and How to Include People with Disabilities in Your Emergency
Planning Process,” by June I. Kailes. This paper can be found on the
www.nobodyleftbehind2.org website under findings.
Offices and organizations that could help get emergency managers in touch with
qualified persons with disabilities to serve on planning committees are Governor’s
Offices on Disabilities, the Statewide Independent Living Council (SILC), and local or
regional centers for independent living (CILs). Resource directories for the SILC and
CILs by state can be found on http://www.ilru.org/html/publications/directory/index.html.
2
Staff. (2005, August). Analysis of local emergency management plans to determine whether
the needs of persons with mobility limitations are being met. Lawrence, KS: The Research and
Training Center on Independent Living, University of Kansas.
3
Staff. (2005). Nobody Left Behind: Objective three, focus area: Assurance and policy
development recommendations. Lawrence, KS: The Research and Training Center on
Independent Living, University of Kansas.
5
Emerging Best Practices
The 30 sites randomly selected for the NLB project and other sites, as
recommended by advisors and consultants, were investigated by the researchers with
an eye for exemplary policies, practices, or programs to assist persons with mobility
impairments. Four such cases were identified. Two exemplary practices were from
sites that had also self-identified in the NLB study as having guidelines in their local
plans to assist persons with mobility impairments. The researchers termed these
exemplary policies, practices, and programs as “emerging best practices.”
The emerging best practices are in: 1) comprehensive planning for persons with
disabilities in the local emergency management plan 2) comprehensive planning tool
using surveillance and consumer education; and 3) day to day surveillance and
consumer education outreach.
Comprehensive planning in local emergency management plans. The
optimal approach to comprehensive planning is an extensive set of guidelines in the
local emergency plan to address the needs of persons with disabilities. One site did just
this by creating an “Appendix on Persons with Disabilities” to the Annex on Direction
and Control in their local emergency management plan. Attachment 3 of this report is
that Appendix with slight modifications in formatting and to remove the identity of the
site. Attachment 4 is the corresponding self-registry form for persons with disabilities.
The provisions of the Appendix take a multi-disability approach (sensory,
physical, and emotional/mental), set minimum training and reception care requirements,
seek inclusion of persons with disabilities, and place responsibilities on persons with
disabilities and other responders in participation with preparedness and the plan.
Attachment 4 is the self registry form that corresponds with the first directive that
persons with disabilities make their needs known and prepare themselves for potential
emergencies. The Appendix on Persons with Disabilities can be used as a model with
minor adjustments to fit many local systems. It is an excellent starting point to bridge
gaps in assistance measures for persons with disabilities, while providing for more
knowledgeable and confident emergency management teams to address these needs.
Another component of this Appendix is it utilizing persons with disabilities in the
training exercise. For those managers considering providing training and exercises that
include persons with disabilities an excellent resource is: Incorporating Special Needs
Populations into Emergency Planning and Exercises" by E. Davis and J. Mincin (2005,
June). This paper can be found on www.noodyleftbehind2.org under findings.
Comprehensive planning tool using surveillance and consumer education.
During the NLB study, it was discovered that one site was utilizing a best practice, fielddeveloped, surveillance and consumer education model. It brings the health field and
emergency management together to map the assistance needs of a community to best
design non-medical and medical assistance. This planning tool relies on consumer
education and participation. Survey questionnaires are included in the consumer
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education packet or online at a website. The questionnaires allow for the intake of
assistance information such as physical location, medical needs, medication, mobility,
and medical history. The consumer packets are distributed by mail, Meals on Wheels,
Area Agencies on Aging, and home health agencies in this Texas model. Recently,
distribution has occurred through churches utilizing the Faith-Based nursing program
(Parish Nurses). Using the provided database software to map the various types of
assistance needs and locations, planners can determine the placement of shelters,
staffing, and medical equipment and supplies.
Patti Moss, RN, MSN, at the Lamar University Department of Nursing created
this tool for local adoption and it is called “The Disaster Preparedness Planning for the
Special Needs Population." (See Attachment 5 for website to obtain the database
software, special needs assessment survey, survey questionnaires, and consumer
education packet.) Existing shelters developed through this model were tested under
the conditions of Florida hurricanes and Hurricane Rita. This tool is being used by
several emergency managers in Texas, Louisiana, and Florida. In 2006, the State of
Texas went live with a modified version of this database model, through the 2-1-1
program, in order to establish the State of Texas Registry.
Day-to-day consumer and surveillance outreach. One site in the NLB study
stood out with its “accumulative effect of several policies and practices” aimed at
meeting the needs of specific individuals with disabilities. Good management, a
workable self-identifying registry, consumer education, and adequate resources were a
part of the success of this operation as well. The emergency manager took the
consumer and surveillance outreach program designed for the part of the county that
encompassed a 10 mile radius of the nuclear power plant and expanded it to cover the
entire county. The end result translated into excellence in meeting the individual
assistance needs of persons with various disabilities across this rural county.
Some 20 years ago, the emergency
management and nuclear industry used a
“One thing that … would be
calendar as a means to provide the public
valuable with jurisdictions … an
with safety and evacuation routes in case
educational program for persons
of a nuclear power or other emergency.
with disabilities that would
This site has found that changing the
prompt them to contact the local
theme of the calendar with local
dispatch center to apply
attractions, photos or other points of
pertinent information in the
interest each year on the calendar has
[dispatch] system.”
kept the attention of the public. It has
Emergency Manager, NLB Study
become the best tool to have safety
information readily available to the public. Along with the calendar, each household in
the county gets a postage paid registration card. This card is to be filled out if anyone in
the household requires assistance during disasters. Knowing these individual needs
and residencies helped the emergency manager create an environment to meet those
needs. For example, when the emergency management office was relocating, it built in
7
the capacity to serve as a special medical needs shelter and the entrance and
bathrooms of the building were made accessible.
The emergency manager also has built upon small community scale of knowing
one another and responding. For example, volunteers have been recruited from the
county road and bridge staff to go to the homes of persons in the rural countryside who
need assistance with evacuation or to receive warnings.
The office also has adequate staffing and financial support due to the tax
revenue generated from the local nuclear power plant. Otherwise, the staff for an office
that size would have been a part-time manager rather than three full-time staff persons.
The nuclear power plant money pays for the calendars, inserts, and mailings, The
county pays for the registry, and this information is shared with 911. One staff person
maintains the registry and interagency exchange of information.
Required Resources for Guidelines
The emergency managers in the NLB study who did not include people with
disabilities in their local emergency management plan said to create such guidelines,
such as the Appendix on Person with Disabilities ( Attachment 3), requires one or more
additional resources. 4 Table 2 illustrates the resources identified by the emergency
managers as needed to develop guidelines to assist persons with disabilities. A
majority required additional funding while other resources included trained personnel, a
mandate, and additional public education efforts.
Table 2
Resources Needed to Develop Guidelines in Local Emergency
Management Plans on the Needs of Persons with Disabilities and
the Percentage of these Managers Needing Specific Resources
____________________________
______ ________________
Resources Needed to
Percentage of Managers Needing
Develop Guidelines
Resource to Develop Guidelines__
Financial Resources
67%
Knowledgeable and Trained Personnel
33%
A FEMA, State, or County Mandate
25%
Greater Public Education Efforts
17%
____________________________
_____
4
Michael Fox presented PowerPoint, “County Level Disaster Preparedness and Response for
Person with Mobility Impairments: Results from the University of Kansas Nobody Left Behind
Study” by Michael H. Fox, Sc.D., Glen W. White, Ph.D., Catherine Rooney, M.A., and Jennifer
Rowland, Ph.D., P.T., at the Centers For Diseases Control and Prevention, Public Health
Preparedness Conference, Atlanta GA, 2/22-24/05. This can be found at
www.nobodyleftbehind2.org under PowerPoint Presentations.
8
Discussion
Summary
More attention is required in local emergency management systems to effectively
address the needs of persons with mobility impairments and other disabilities. An
emerging best practice is to create an extensive approach to addressing the needs of
persons with disabilities by developing an Appendix on Persons with Disabilities in the
local emergency management plan (see Attachment 3 for Appendix example). Another
emerging best practice is a workable database design for mapping local and state
consumer medical and non-medical assistance needs for the planning of special
medical needs shelters. (See Attachment 5 for this model.) Other factors that
contributed to best practices included proactive management, effective consumer
education, and adequate resources. Each of the exemplary and best practices
scenarios can be used as models and, with minor adjustments, fit many local systems.
Their scopes can also be expanded to address other gaps in services or policies.
Regardless of which direction an emergency management offices takes, it is important
to encourage the inclusion of persons with disabilities. A majority of the emergency
managers without guidelines stated they required additional funding, trained personnel,
a mandate, and additional public education efforts.
Policy changes are also needed to get emergency management and response
personnel educated in disability sensitivity and specific disability related needs that
encompass the broad spectrum of disabilities (sensory, physical and emotional/
cognitive). Prevention saves lives, so additional emphasis and resources need to go
towards distribution of existing disability related preparedness information to the
disability community as well as the creation of new materials.
The infrastructure of local
“It would be helpful if FEMA
emergency management offices
incorporated more training in
needs to be strengthened. This may
dealing with people with mobility
include the resources for emergency
impairments.”
managers to receive and offer training
Emergency Manager, NLB Study
dealing with persons with disabilities
and their emergency management needs, create surveillance resources for
identification of persons with disabilities, offer outreach materials for preparedness for
persons with disabilities, and seek their input into the emergency management process.
Previous NLB research findings indicated there is limited attention by emergency
managers on taking courses regarding persons with disabilities. This may be in part due
to past policy decisions, particularly within FEMA, to focus the original required training
and operational structure of emergency planning and response on the needs of the
general population. Thus, learning about and planning for the needs of the so called
“special needs populations,” which includes persons with disabilities, becomes optional.
Given this mind set, it is evident from the interviews of the emergency managers that
the managers are interested and committed to providing quality services to all
9
constituents in their service areas. It is recommended that persons with disabilities be
taken out of the category of special needs populations. By doing this, persons with
disabilities would automatically be included in the overall training components for
emergency management. However, additional continuing training options should be
encouraged and promoted by policy makers as no one course to date is a true model
training program.
Another resource on the topic of appropriate terminology in the field is from a
white paper commission by the NLB project: Disaster Services and “Special Needs”:
Term of Art or Meaningless Term?” by June I. Kailes. This paper can be found on
www.noodyleftbehind2.org under findings.
Limitations
For the purposes of developing a full scale resource guide, the size of the NLB
sample was too small to obtain more than a few examples of exemplary and emerging
best practices. Another approach designed specifically to collect and systematically
review possible best practices is recommended. In addition, very few local emergency
management plans were submitted to the researchers for review since the documents
were frequently revised, security reasons, and because of the hassle of reproducing the
document. Thus, the researchers had to rely on the self identification from the
managers about having guidelines to meet persons with mobility impairments. It
became evident during the interviews that some type of checklist on possible policies
and practices constituting assisting persons with mobility impairments would be helpful.
Without this list, emergency managers had to decide on their own what constitutes
addressing needs. So, what one manager thought was not a specific policy or practice
another might have thought it was such as special medical needs shelters.
Conclusion
The media coverage of the plight of the disabled, elderly, and poor from the
aftermath of Hurricane Katrina in New Orleans is making policy makers’ examine the
system that failed. Attention is now being given to the assistance required of special
needs populations which currently encompasses disabilities. The time is right to reexamine the mind set of the past and to address shortcoming in the field as a whole.
Who best can direct the changes other then emergency managers with exemplary
practices. Taking research and placing it into practice is the next challenge to advance
practices in the field. As the saying goes “An ounce of prevention is worth a pound of
cure.” Each of the emerging best practices presented in this white paper are a separate
ounce of prevention. They can be modified to meet specific local needs and be
implemented with support from policy makers in emergency management and
disabilities community.
10
This report was created by the Research and Training
Center on Independent Living and does not necessarily
reflect the views of the funder or the University of Kansas.
Any use of the contents of this report should be followed by
this citation: The Research and Training Center on
Independent Living, The University of Kansas (2007, March),
Nobody Left Behind: Briefing Paper: Objective Three, Part 2 Focus Area: Report on Exemplary
and Best Practices in Disaster Preparedness and Response for People with Disabilities.
Lawrence, KS: Nobody Left Behind staff. For more information, refer to
www.nobodyleftbehind2.org
11
Attachment 1
Exemplary and Best Practices
Inclusion of Persons with Disabilities
Do’s and Don’ts Checklists for Individual Disaster Preparedness
for and by Persons with Mobility Impairments
12
Attachment 2
Exemplary and Best Practices
Inclusion of Persons with Disabilities
Do’s and Don’ts Checklists for Community Disaster Preparedness Involvement
for and by Persons with Mobility Impairments
13
Attachment 3
Exemplary and Best Practices
Comprehensive Planning in Local Emergency
Management Plan
Appendix on Persons with Disabilities
Annex-Direction and Control
I. The following considerations must be addressed in order to integrate matters relating
to persons with disabilities into all planning and procedural activities.
A. Identification
1. Active participation by persons with disabilities in the identification process is
required in order to provide effective assistance.
2. Persons with disabilities must take responsibility for registering with
emergency response agencies, making their needs known, and preparing
themselves for potential emergencies to the maximum extent possible within
their means.
B. Systems to provide alert or warning include, but are not limited to:
1. Open-captioned television.
2. Commercial radio Emergency Alert System (EAS).
3. Media Alert through Department of Public Safety.
4. Telecommunication devices for hearing/speech impaired persons (TT).
5. Standard warning systems such as sirens, klaxons, and public address
loudspeaker systems.
6. House-to-house notification by law enforcement, fire, or other emergency
response personnel.
7. Neighborhood watch/assistance programs.
8. Basic emergency sign language for persons who are deaf or hearingimpaired.
14
C. Training and exercises involving evacuation of persons with disabilities should
emphasize:
1. How to address and relate to persons with disabilities.
2. How to guide persons with visual impairments.
3. Emergency sign language and finger spelling.
4. How to handle mentally impaired individuals in an emergency.
5. The use of specialized mobility equipment.
6. Moving individuals who use a breathing apparatus or other life-sustaining
equipment.
7. How to move/transfer the bedridden and frail elderly.
8. Safe handling procedures for individuals who use a wheelchair or other assistive
device.
9. The importance of taking medications and other items along with the evacuee.
10. Characteristics of an emergency call from persons with disabilities.
11. How to rescue persons with disabilities from para-transit vans and buses.
D. Reception and care centers for use by persons with disabilities must be identified as
such.
The unique requirements of such facilities include:
1. Ramp entrances/exits.
2. Accessible rest rooms with 60" x 60" or larger stalls.
3. Refrigeration for medications.
4. Emergency electric generator for respiratory and other equipment.
5. Oxygen availability.
6. Facilities for accommodating service animals for persons with disabilities.
E. Specific Tasks
1. County Department of Emergency Management
a. Assist agencies without emergency plans to develop such plans.
15
b. Conduct or participate in seminars or workshops for staffs of agencies
that serve persons with disabilities to provide information relating to
emergency response alerts, warnings, sheltering, evacuation procedures,
and other related matters.
c. Install a TT device for speech/hearing impaired persons in the EOC and
train the staff in its use.
2. Sheriff's Office
a. Participate in emergency preparedness planning, as required, for
agencies representing or providing services to persons with disabilities.
b. Assist in the notification, warning, and evacuation of persons with
disabilities.
c. Communicate with hearing impaired individuals at the Sheriff's
communications center.
3. American Red Cross Chapter
a. Identify and designate reception and care facilities capable of
accommodating persons with disabilities.
b. Provide emergency vehicles and drivers to transport disabled evacuees
to reception and care centers.
4. Persons with Disabilities
a. Be aware of individual warning, evacuation, and sheltering needs.
b. Register with the local emergency services organization if special
warning procedures, evacuation assistance, and/or special shelter
facilities are needed (See Appendix 2 of this report).
c. Maintain stocks of supplies, equipment, and medications which may be
required for a minimum of three days in a shelter.
d. Be aware of county warning procedures, evacuation plans, and shelter.
16
Attachment 4
Example of Self-Registry Form that
Corresponds with Attachment 3
Completion of this form is voluntary.
The information requested on this form is needed to assist emergency response
agencies and their personnel in the event of an emergency to locate, warn and, if
necessary, evacuate persons with disabilities.
The information will be held in strict confidence and will be disclosed only to authorized
members of the (name of the city or town goes here) emergency response
organization as described in the (name of the city or town goes here) Emergency
Operations Plan.
When the form is completed, mail it to the (name of the city or town goes here) or
phone (name of the city or town phone number goes here) and a member of the
(city or town) emergency response organization will pick it up at your residence.
Name
Phone
Address
Date of Birth
Preferred/Required Form of Notification:
Telephone
Flashing Light or Other Visual Method
In Person
Tell Neighbor/Relative Listed Below
Written
TT
Relative/Friend who can provide assistance:______________________________
Address
Phone
Family Physician
Phone
Type of Disability
17
Attachment 5
Exemplary and Best Practices
Comprehensive Planning Tool uses Surveillance
and Consumer Education
“The Disaster Preparedness Planning for
the Special Needs Population”
This planning and educational tool is provided by Patti Moss, Lamar University,
Department of Nursing and retired Sgt. Robert Smith, police department and
emergency management. It can be found at www.disaster-research.us and the website
contains:
1.
Database software (also available on CD).
2.
Special needs assessment survey.
3.
Survey questionnaires.
a. Non-medical for database registry.
b. Special needs evacuation form to gather planning information.
4. Consumer education packet.
5. PowerPoint on background and use of the tool.
18